Provider Demographics
NPI:1215473590
Name:FISHER, CHRISTINA DAWN (LCSW)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:DAWN
Last Name:FISHER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:DAWN
Other - Last Name:MCLEOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2940 JOHNSON FERRY RD STE B-127
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-8361
Mailing Address - Country:US
Mailing Address - Phone:678-637-7166
Mailing Address - Fax:
Practice Address - Street 1:2940 JOHNSON FERRY RD STE B-127
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-8361
Practice Address - Country:US
Practice Address - Phone:678-637-7166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-11
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0056071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical